Circulation: Cardiovascular Interventions最新文献

{"title":"Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation: The PRIME-MR Registry.","authors":"Andrea Scotti, Sebastian Ludwig, Daniel Feldman, Benedikt Koell, Jessica Weimann, Philipp von Stein, Alejandro Araujo Adams, Adrian Heinze, Dhairya Patel, Lukas Stolz, Robin Le Ruz, Tetsu Tanaka, Teresa Trenkwalder, Felix Rudolph, Daryoush Samim, Cristina Giannini, Julien Dreyfus, Jean-Michel Paradis, Marianna Adamo, Nicole Karam, Yohann Bohbot, Anne Bernard, Bruno Melica, Yusuke Kobari, Yoan Lavie-Badie, Mirjam Kessler, Omar Chehab, Simon Redwood, Edith Lubos, Ole de Backer, Marco Metra, Marcel Weber, Tanja Rudolph, Chiara Primerano, Marco De Carlo, Christos Iliadis, Fabien Praz, Muhammed Gerçek, Erion Xhepa, Georg Nickenig, Raj Makkar, Jörg Hausleiter, Erwan Donal, Rodrigo Estévez-Loureiro, Ignacio Cruz-González, Juan Granada, Thomas Modine, Augustin Coisne, Daniel Kalbacher, Azeem Latib","doi":"10.1161/CIRCINTERVENTIONS.126.016634","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016634","url":null,"abstract":"<p><strong>Background: </strong>The presence of tricuspid regurgitation (TR) may affect prognosis in patients with primary mitral regurgitation. This study sought to investigate the impact of concomitant TR on clinical outcomes in patients with primary mitral regurgitation undergoing mitral transcatheter edge-to-edge repair (M-TEER).</p><p><strong>Methods: </strong>The PRIME-MR registry (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation) included 3083 patients with severe primary mitral regurgitation undergoing M-TEER from 2008 to 2022 at 25 international sites. Only patients with successful M-TEER procedures (mitral regurgitation≤Moderate) were analyzed. The study population was stratified by baseline TR severity: TR≤Moderate (TR≤Mod) versus TR≥Severe (TR≥Sev). The primary end point was 2-year all-cause mortality.</p><p><strong>Results: </strong>A total of 2155 patients were analyzed: TR≥Sev (n=421 [20%]) versus TR≤Mod (n=1734 [80%]). Patients with TR≥Sev were more likely to be New York Heart Association III/IV (<i>P</i>=0.003), have shorter 6-minute walk distance (<i>P</i><0.001), higher NT-proBNP (N-terminal pro-B-type natriuretic peptide; <i>P</i><0.001), higher creatinine (<i>P</i><0.001), higher pulmonary artery pressures (<i>P</i><0.001), atrial fibrillation (<i>P</i><0.001), and more diuretics (<i>P</i><0.001) than those with TR≤Mod. At 2 years, patients with TR≥Sev had higher mortality (29.6% versus 19.6%; <i>P</i>_log-rank<0.0001) and heart failure hospitalization (21.1% versus 16.8%; <i>P</i>_Gray=0.018) than TR≤Mod. Baseline TR≥Sev was an independent predictor of 2-year mortality (adjusted hazard ratio, 2.01 [95% CI, 1.35-3.00]; <i>P</i><0.001). Although TR≥Sev decreased in 30% of patients after successful M-TEER, residual TR≥Sev was still associated with higher mortality (30.4% versus 19.9%; <i>P</i>_log-rank=0.0037) than TR≤Mod.</p><p><strong>Conclusions: </strong>In the PRIME-MR registry, 20% of patients with primary mitral regurgitation had severe TR at baseline. TR severity improved in 30% of TR≥Sev patients after successful M-TEER. The presence of TR≥Sev was independently associated with increased all-cause mortality at 2 years.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016634"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aberrant, Elevated Papillary Muscle and LV Wall Forces Associated With Mitral Valve Prolapse Are Normalized by Surgical Neochordal Repair but Not by Transcatheter Edge-to-Edge Repair.","authors":"Matthew H Park, Antonia van Kampen, Chris Huynh, Katrina Liou, Lisa Lee, Serguei Melnitchouk, Yuanjia Zhu, Stefan Elde, Alexander K Reed, Gabe Weininger, Michael A Borger, Robert A Levine, Y Joseph Woo","doi":"10.1161/CIRCINTERVENTIONS.125.016161","DOIUrl":"10.1161/CIRCINTERVENTIONS.125.016161","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have linked mitral valve prolapse to increased papillary muscle (PM) traction in mitral valve prolapse and MitraClip patients. We aimed to biomechanically compare edge-to-edge repair via MitraClip implantation and neochordal repair for mitral valve prolapse on PM forces ex vivo.</p><p><strong>Methods: </strong>We developed a force transduction system to measure the forces exerted on the PMs throughout the cardiac cycle in a left heart simulator. Using a randomized, paired procedure with porcine mitral valves (n=8), we measured the hemodynamic parameters and PM forces for control, prolapse, chordal rupture, MitraClip edge-to-edge repair, surgical edge-to-edge repair, and neochordal repair conditions.</p><p><strong>Results: </strong>Hemodynamic parameters, including maximum ventricular pressure and transmitral pressure gradients, remained consistent across all experimental conditions. The rupture condition induced pathological mitral regurgitation relative to control valves (23.7±18.5% versus 3.1±1.0%; <i>P</i><0.001). In the chordal rupture model, composite peak PM forces were 7.8±1.3 N, ≈16% higher than baseline control valves (6.7±0.7 N, <i>P</i>=0.005). Both surgical and transcatheter edge-to-edge repair conditions resulted in significantly higher peak PM forces compared with both baseline (<i>P</i><0.001) and diseased prolapse conditions (<i>P</i>=0.03). MitraClip repair valves recorded peak PM forces ≈23% higher than those of baseline control valves. Neochordal repair of the prolapsed model resulted in significant reductions of peak PM forces to near-baseline levels (6.8±1.3 N; <i>P</i>=0.53). All repair conditions reduced mitral regurgitation levels to moderate (<15%).</p><p><strong>Conclusions: </strong>We demonstrated that MitraClip, while reducing regurgitation, increases aberrant forces on the PMs. In contrast, neochordal repair both reduces regurgitation and restores PM forces back to physiological levels. Our work suggests that these elevated forces, associated with mitral valve prolapse and MitraClip, predispose the mitral valve to continued traction, altering the mechanical load on the subvalvular apparatus.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016161"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral Regurgitation and Severe Aortic Stenosis: Clinical Characteristics, Prognostic Impact, and Response to TAVR: Insights From Egnite Data.","authors":"Benjamin E Peterson, Philippe Généreaux, Pinak Shah, Tsuyoshi Kaneko, Sammy Elmariah, Michael Dobbles, Rahul Sharma, Sreekanth Vemulapali, Santiago A Garcia, Brian K Whisenant, Matthew Summers, Deepak L Bhatt","doi":"10.1161/CIRCINTERVENTIONS.126.016578","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016578","url":null,"abstract":"<p><strong>Background: </strong>Aortic stenosis (AS) and mitral regurgitation (MR) frequently co-occur, complicating diagnosis and treatment. We examined current US treatment trends and patient outcomes among patients with severe AS and at least moderate MR.</p><p><strong>Methods: </strong>We analyzed data from 2 992 362 patients (aged ≥18 years) undergoing 5 245 904 echocardiograms at 43 US institutions (Egnite Database; Egnite, Aliso Viejo, CA, with permissions) to identify a cohort of patients with severe AS and moderate or greater MR. The primary end point was 2-year all-cause mortality, assessed via Kaplan-Meier analysis. For patients undergoing transcatheter aortic valve replacement (TAVR) alone, MR severity changes from baseline to 45 days post-TAVR were visualized using Sankey diagrams.</p><p><strong>Results: </strong>The cohort included 36 402 patients (mean age, 78.2 years; 54.6% male), of whom 52.0% were untreated, 36.5% underwent TAVR alone, and 11.5% underwent surgery or other transcatheter interventions. Two-year mortality for untreated patients was 36.8% (95% CI, 35.6%-38.0%) for AS with less than moderate MR, 57.3% (95% CI, 54.0%-60.6%) for AS with moderate MR, and 65.5% (95% CI, 60.9%-70.1%) for AS with moderate-to-severe or severe MR (log-rank <i>P</i><0.001). Undertreatment was more frequent in patients with AS and significant MR (64.5% versus 49.9%, <i>P</i><0.001). Among patients undergoing TAVR alone with follow-up MR data, 77.5% demonstrated improvement in MR.</p><p><strong>Conclusions: </strong>Patients with concurrent MR and AS exhibit substantially higher mortality yet have high rates of undertreatment throughout the duration of follow-up. TAVR alone significantly improves MR in most patients.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016578"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter Edge-to-Edge Repair in Older Adults With Mitral and Tricuspid Valve Disease.","authors":"Radwan Alkhatib, Taha Hatab, Maha Alfaraidhy, Nishok Karthikeyan, Oliver Glen M Ancheta, Mauricio G Cohen, Samir Kapadia, Venu Menon, Michael G Nanna, Abdulla A Damluji","doi":"10.1161/CIRCINTERVENTIONS.126.017207","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017207","url":null,"abstract":"<p><p>The older adult population is expanding rapidly. Parallel to this expansion, cardiologists care for a larger population of patients with clinically significant mitral regurgitation and tricuspid regurgitation who are ineligible for surgical repair due to frailty, multimorbidity, and coexisting geriatric conditions. Transcatheter edge-to-edge repair has emerged as a safe and effective alternative, with randomized trials and contemporary registries demonstrating durable reduction in regurgitation, improved functional status, and lower heart failure hospitalizations across age groups. Integration of geriatric cardiology tools to address frailty, cognition, delirium risk, nutrition, polypharmacy, and social support is critical to optimize procedural outcomes. Tools including the Comprehensive Geriatric Assessment, Mini Nutritional Assessment-Short Form, Katz Index of Independence in Activities of Daily Living, Kansas City Cardiomyopathy Questionnaire, and cognitive screening instruments enable individualized risk stratification and care planning. Periprocedural and postprocedural strategies, including structured rehabilitation, early mobilization, delirium prevention, and caregiver engagement, further enhance functional recovery. Despite favorable procedural outcomes, significant gaps remain in the care for older adults, including the inconsistent characterization of frailty and cognitive status in clinical trials, which limits evidence to guide selection, limited transcatheter edge-to-edge repair-specific tools to assess age-associated risks, and scarcity of long-term data on functional independence and quality-of-life end points. Future research should prioritize patient-centered outcomes and develop integrated, multidisciplinary care pathways that align procedural success with meaningful life expectancy and functional longevity in older adults.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017207"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Initial Valve Type on Reintervention for TAVR Failure: From the EXPLANTORREDO-TAVR International Registry.","authors":"Syed Zaid, Tsuyoshi Kaneko, Ole De Backer, Sachin S Goel, Paolo Denti, Thomas Modine, Tamim N Nazif, Martin B Leon, Michael J Mack, Vinayak N Bapat, Gilbert H L Tang","doi":"10.1161/CIRCINTERVENTIONS.126.016705","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016705","url":null,"abstract":"<p><strong>Background: </strong>As transcatheter aortic valve replacement (TAVR) expands to younger patients, there is limited data on the impact of TAV type on outcomes of TAVR-explant and redo-TAVR for TAVR failure. We sought to compare outcomes of reintervention for failed balloon-expandable valves (BEV) versus self-expanding valves (SEV).</p><p><strong>Methods: </strong>From May 2009 to February 2022, 553 patients from 29 centers in the international EXPLANTORREDO-TAVR registry underwent redo-TAVR or TAVR-explant for TAVR failure during a separate admission from index TAVR. Mechanically expanding valves and explantation for endocarditis were excluded. 158 (41.4%) failed-BEV were compared with 224 (58.6%) failed-SEV, and outcomes were reported at 30 days and 1 year.</p><p><strong>Results: </strong>Mean age at reintervention was 75.5±9.3 years, and 40.6% were female. Failed-BEV had higher proportion of structural valve deterioration (73.4% versus 46.1% in failed-SEV; <i>P</i><0.001) and prosthesis-patient mismatch (12.3% versus 5.5%, <i>P</i>=0.022) and fewer paravalvular leak (18.2% versus 41.1%; <i>P</i><0.001) paralleling a longer time-to-reintervention (41.8 versus 19.7 months; <i>P</i><0.001). Reintervention strategy was nearly identical between groups (redo TAVR 54.4% failed-BEV versus 53.6% failed-SEV; TAVR-explant 45.6% versus 46.4%; <i>P</i>=0.92), with cross-platform redo-TAVR favored in both groups (58.1% of failed-BEV received SEV; 59.2% of failed-SEV received BEV; <i>P</i>=0.016). Compared with failed-SEV, reintervention for failed-BEV had similar mortality at 30 days (8.7% versus 8.0%; <i>P</i>=0.85) and 1 year (24.3% versus 21.5%; <i>P</i>=0.65), with no differences in risk-adjusted 3-year cumulative mortality when stratified by reintervention type (redo TAVR: adjusted hazard ratio, 1.15 [0.61-2.20]; ref: failed-BEV); TAVR-explant: adjusted hazard ratio, 0.84 [0.46-1.54]).</p><p><strong>Conclusions: </strong>Failed-BEV and failed-SEV showed distinct failure mechanisms and timing of reintervention, but initial valve type did not impact reintervention strategy or survival after redo-TAVR or TAVR-explant.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016705"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Trends for the Treatment of In-Stent Restenosis in the United States, 2009 to 2024.","authors":"Husam M Salah, Tess Allan, Tyler Gillikin, Angel Marks, Daniel M Wojdyla, Jacob A Doll, Roxana Mehran, Manesh R Patel, W Schuyler Jones, Sunil V Rao, Jennifer A Rymer","doi":"10.1161/CIRCINTERVENTIONS.126.016533","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016533","url":null,"abstract":"<p><strong>Background: </strong>In-stent restenosis (ISR) remains an important cause of repeat revascularization despite advances in drug-eluting stent technology. Contemporary adoption patterns and outcomes of adjunctive plaque-modification strategies for ISR are incompletely characterized. We evaluated national trends and in-hospital outcomes of ISR percutaneous coronary intervention treated with adjunctive plaque-modification devices versus conventional plain old balloon angioplasty.</p><p><strong>Methods: </strong>All ISR percutaneous coronary intervention procedures in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to June 2024 were analyzed. Adjunctive ISR therapy was defined as use of excimer laser atherectomy, intravascular lithotripsy, cutting/scoring balloon angioplasty, or rotational/orbital atherectomy with or without stent implantation. Conventional plain old balloon angioplasty included balloon angioplasty with or without stent placement and no adjunctive devices. Multivariable logistic regression clustered by operator was used to assess adjusted in-hospital outcomes.</p><p><strong>Results: </strong>Among 1 065 354 ISR admissions (1 182 599 lesions), adjunctive devices were used in 26.5% of cases, increasing from 20.8% in 2018 Q1 to 40.7% by 2024 Q2. Intravascular lithotripsy showed the most rapid adoption, reaching 16.1% of ISR cases within 4 years of US introduction. Adjunctive therapy was associated with higher odds of in-hospital mortality (odds ratio, 1.25 [95% CI, 1.19-1.31]), myocardial infarction (odds ratio, 1.30 [95% CI, 1.24-1.35]), bleeding (odds ratio, 1.29 [95% CI, 1.26-1.33]), and stroke (odds ratio, 1.11 [95% CI, 1.02-1.22]). Recurrent ISR (14.3%) was more often managed with adjunctive therapy (34.2% versus 25.0% for initial ISR) yet had lower absolute complication rates.</p><p><strong>Conclusions: </strong>ISR remains a major contributor to percutaneous coronary intervention volume. Use of adjunctive plaque-modification devices, especially intravascular lithotripsy, has risen sharply. Adjunctive therapy was associated with higher in-hospital event rates, likely reflecting lesion complexity.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016533"},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of a Dedicated TAVR Device for Native Aortic Regurgitation: Insights From a Multicenter Real-World Experience.","authors":"Hendrik Wienemann, Sara Yousefzada, Marc Adrian Rogmann, Kush P Patel, Mohamed Abdel-Wahab, Daniel J Blackman, Yusuke Kobari, Daniel Schwarzkopf, Elmar W Kuhn, Georges El-Hachem, Noman Ali, Hristian Hinkov, Axel Unbehaun, Ole de Backer, Andreas Baumbach, Martin Geyer, Tanja K Rudolph, Matti Adam","doi":"10.1161/CIRCINTERVENTIONS.126.016851","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016851","url":null,"abstract":"<p><strong>Background: </strong>The JenaValve Trilogy Transcatheter Heart Valve System (Trilogy) is a CE-marked transcatheter aortic valve replacement device designed for the treatment of symptomatic aortic regurgitation. Despite its unique indication, data from large cohorts remain limited. This study aimed to evaluate procedural characteristics and clinical outcomes in all-comers patients with symptomatic aortic regurgitation undergoing transfemoral transcatheter aortic valve replacement with the Trilogy valve.</p><p><strong>Methods: </strong>This multicenter retrospective analysis included patients with symptomatic aortic regurgitation who underwent Trilogy implantation between June 2021 and June 2025 at 8 European centers. Baseline, procedural, and follow-up data were collected according to local protocols, and outcomes were defined per VARC-3 (Valve Academic Research Consortium-3).</p><p><strong>Results: </strong>A total of 363 patients (median age, 81 years [interquartile range, 75-84]; 45% female patients; median European System for Cardiac Operative Risk Evaluation II, 3.4%; median left ventricular ejection fraction, 50%) were included. Transfemoral access was used in 359 (99%), and technical success was achieved in 98%. Valve embolization occurred in 5 patients: 2 managed with a second valve, 2 surgically, and 1 required valve-in-valve reintervention. Two additional technical failures involved hemodynamic instability and a vascular complication. At discharge, 86% had none or trace leakage, and the mean transvalvular gradient was 4 mm Hg. Permanent pacemaker implantation was required in 22%. In-hospital mortality was 0.3%. At 30 days, functional status had improved markedly, with 88% of patients in New York Heart Association class I or II. Kaplan-Meier estimated all-cause mortality at 6 months, 1, 2, and 3 years was 4.1%, 7.0%, 15.8%, and 25.9%, respectively, among patients with available follow-up.</p><p><strong>Conclusions: </strong>In this large analysis, transfemoral transcatheter aortic valve replacement with the Trilogy valve demonstrated high procedural success and favorable hemodynamic valve performance. These findings are encouraging and suggest a potential role for the Trilogy valve in patients with symptomatic aortic regurgitation who are unsuitable for surgery.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016851"},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Angiographic Identification of Culprit Lesions in Women With MINOCA.","authors":"Elianna M Shwayder, Vincent Li, Claudia Serrano Gomez, Binita Shah, Lindsay Elbaum, Judith S Hochman, Anaïs Hausvater, Akiko Maehara, Mitsuaki Matsumura, Tara Sedlak, Jacqueline Saw, Chang Yu, Harmony R Reynolds, Nathaniel R Smilowitz","doi":"10.1161/CIRCINTERVENTIONS.126.016979","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.016979","url":null,"abstract":"<p><strong>Background: </strong>Myocardial infarction with nonobstructive coronary arteries (MINOCA) accounts for 6% to 15% of acute coronary syndromes and disproportionately affects women. Although coronary culprit lesions are present in 45% of patients with MINOCA, multivessel optical coherence tomography (OCT) is infrequently performed. We evaluated whether interventional cardiologists can identify coronary arteries with culprit lesions using invasive coronary angiography in women with MINOCA.</p><p><strong>Methods: </strong>Women with MINOCA who had a coronary culprit lesion identified by multivessel OCT were included. A core laboratory confirmed and localized OCT-defined culprit lesions using angiographic coregistration. Two interventional cardiologists blinded to OCT findings independently reviewed invasive coronary angiography, before and after review of ECG and transthoracic echocardiography, to identify the culprit artery.</p><p><strong>Results: </strong>Among 64 women with MINOCA (median age 64 years; 97% non-ST-segment elevation MI), OCT-defined culprit lesions were most frequently located in the left anterior descending (50.8%) or right coronary (35.4%) arteries. At least 1 interventional cardiologist identified the culprit artery in 54.7% of patients (95% CI, 42.6%-66.3%); both identified it in 28.1% (95% CI, 18.6%-40.1%). The addition of ECG and transthoracic echocardiography data did not improve accuracy (<i>P</i>=0.40 and <i>P</i>=0.97). Culprit arteries were identified by at least 1 cardiologist in 87.5% of plaque rupture cases. Only 11% of circumflex lesions were identified.</p><p><strong>Conclusions: </strong>Interventional cardiologists could not reliably identify culprit arteries using coronary angiography in women with MINOCA, even after ECG and transthoracic echocardiography review. Our findings suggest that invasive angiography alone should not guide vessel selection for intracoronary imaging and support multivessel imaging when evaluating MINOCA.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT02905357.</p>","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e016979"},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inter-Vessel Heterogeneity of Coronary Vasomotor and Microvascular Dysfunction in ANOCA: Insights Into Multivessel Assessment.","authors":"Takashi Mineo, Yoshihisa Kanaji, Eisuke Usui, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Kai Nogami, Mirei Setoguchi, Tomohiro Tahara, Kodai Sayama, Hikaru Shimosato, Takahiro Watanabe, Masahiro Hoshino, Tomoyo Sugiyama, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta","doi":"10.1161/CIRCINTERVENTIONS.126.017167","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.126.017167","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017167"},"PeriodicalIF":7.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debunking Debulking: What Does Atherectomy Really Do?","authors":"Ziad A Ali, Hirofumi Ohashi, Koshiro Sakai","doi":"10.1161/CIRCINTERVENTIONS.126.017232","DOIUrl":"10.1161/CIRCINTERVENTIONS.126.017232","url":null,"abstract":"","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":" ","pages":"e017232"},"PeriodicalIF":7.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}